My Mom needs a couple of teeth removed. Her communication is severely limited, Novocaine, or Anesthesia?

She has moderate to late stage dementia, we really don't want to go with the Anesthesia, due to past experiences this has put her through. We are not sure she would allow or understand the Novocaine. Any advice?

Answers

I was going to suggest Nitrous oxide gas as well. I agree with ferris1 that if the stage of dementia is advanced and pain isn't the issue it's best just to leave it alone. However, abscesses can be a problem. My mother-in-law needed surgery for that reason. They used a combination of local anesthetics and nitrous. Good luck making this decision. It's a tough one.Carol

I am a dental hygienist an an educator in a dental school. There are several options. One is to take an anti anxiety medication before the appointment at home...most dentists prescribe Valium in low dose. The anesthetic injections ( they no longer use Novocaine) are perfect for extraction. and will wear off and not affect her mentally. You do not say why your concern so more info would be helpful. Is she easily frightened, combative? Nitrous oxide gas (known as laughing gas) is a wonderful sedative and the patient is awake but just sedated and the gas immediately is flushed out with 100% oxygen before she leaves. And therefore she is totally in control and no longer under any influence. I like others would advise against the general anesthetic. But I doubt that is what they would use. I would get an actual name (s) of what they would use as an anesthetic. It may be what is used for procedures like a colonoscopy. The doctor needs a full list of her medications before seeing her that day also. It would be nice if she had already met the doctor first as well.

My mom, with drug-induced dementia from anti-cholinergic meds, was unable to take sedatives. She also experienced significant pain due to joint problems. She'd already had an ankle fusion, both hips replaced, and one new knee. If not for it being age inappropriate, 93 at the time, she would have needed the other knee replaced as well as both shoulders. I couldn't stand to see her in even more pain and fear from worrying about AND having teeth removed. Fortunately, she'd had good experiences with oral surgery, so calm, matter of fact reminding her of that allowed what memory she had left to kick in and allay any fears.

In prior consultation with the OS, I explained her history and suggested that I dose her with her normal pain medication of acetaminophen + tramadol (she also could not take narcotics) along with her soma about 1/2 hour prior to surgery and ask if it would be acceptable that he use nitrous oxide. I asked the OS to please confer with her doctor if necessary. He felt that nitrous in addition to what she was already used to taking would work fine; that nitrous was relatively safe with virtually no side effects and, consequently, he did not feel he needed to conference with her doctor.

Someone mentioned if the teeth aren't hurting leave them alone. Did you all know that any infection in the mouth has access to the entire body via the vessels that supply and drain the tooth? Therefore that same infection can affect the heart, brain, etc. You can get a fatal infection of the heart. Infections can also raise the level of CRP (C reactive protein) in the blood which can lead to strokes. So removing infected teeth with a poor prognosis, whether hurting or not is wise. One British study showed that the same bacteria that we find in periodontal disease (used to be called pyorrhea) can be found in the brains of people with Alzheimers. Our teeth are connected to the body. Ok...off my soapbox now. (can't help it, it's the dental educator in me)

Why put her through the trauma of a dental procedure? Unless the teeth have an absess, or they are painful, do not do anything. She has a terminal illness. Try to make her time left as pleasant as possible.

Agree with Pam. Anesthesia with her dementia is not a good idea. Preferably a sedative that she has tolerated well before, possibly in a larger dose. Dr will advise not just the dentist involve her PCG

My wife would not permit (she would push the dentist hand away) the dentist to inject novocaine. We found a dentist that used a IV sedation (using a certified anesthesiologist -not an MD). This procedure was approved by my wife's family doctor and her neurologist. We used this procedure when a tooth was removed. Also used at lesser time (15 minutes) for general cleaning every 4 months. It has worked fine without any negative results.While I would prefer the use of injected novocaine in lieu of the IV sedation, the need to keep her teeth in good condition ruled the day. Jim W.

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